Quality Review and Audit Analyst - Cigna Healthcare - Remote
About The Position
The Risk Adjustment Quality & Review Analyst supports IFP Risk Adjustment programs by applying medical coding and HCC expertise to review documentation, validate data accuracy, ensure compliance, and identify opportunities for continuous improvement. Key Job Functions Conduct medical record reviews with accurate ICD‑10‑CM diagnosis code abstraction in alignment with official guidelines, Cigna IFP standards, HHS protocols, and applicable rule sets. Validate HCC assignments for the correct Benefit Year using the HHS Risk Adjustment Model. Perform documentation and data audits to identify errors, gaps, and compliance risks across IFP Risk Adjustment programs, including RADV and Supplemental Diagnosis submissions. Support vendor coding quality reviews and collaborate with partners on coding and RA education. Coordinate with internal and external stakeholders to ensure efficient, compliant RA program execution. Escalate risks promptly and communicate clearly across audiences. Support program processes and guideline updates to maintain CMS/HHS compliance, including contributing to Cigna IFP Coding Guideline revisions and policy decisions. Education & Certification High school diploma required. Minimum 2 years experience with one of the following AHIMA/AAPC certifications: CPC, CCS‑P, CCS‑H, RHIT, RHIA, or CRC Non‑CRC holders must obtain CRC within 6 months of hire.
Requirements
- High school diploma required.
- Minimum 2 years experience with one of the following AHIMA/AAPC certifications: CPC, CCS‑P, CCS‑H, RHIT, RHIA, or CRC
- Non‑CRC holders must obtain CRC within 6 months of hire.
- Experience with medical documentation audits and chart reviews
- Strong knowledge of ICD‑10‑CM guidelines
- Familiarity with CMS Risk Adjustment regulations for inpatient/outpatient documentation
- Proficiency with Excel, Word, and Adobe Acrobat
- Detail‑oriented, organized, and self‑motivated
- Ability to meet productivity, accuracy, and timeline standards
- If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Nice To Haves
- HCC coding experience preferred
- Understanding of medical claims submission preferred
Responsibilities
- Conduct medical record reviews with accurate ICD‑10‑CM diagnosis code abstraction in alignment with official guidelines, Cigna IFP standards, HHS protocols, and applicable rule sets.
- Validate HCC assignments for the correct Benefit Year using the HHS Risk Adjustment Model.
- Perform documentation and data audits to identify errors, gaps, and compliance risks across IFP Risk Adjustment programs, including RADV and Supplemental Diagnosis submissions.
- Support vendor coding quality reviews and collaborate with partners on coding and RA education.
- Coordinate with internal and external stakeholders to ensure efficient, compliant RA program execution.
- Escalate risks promptly and communicate clearly across audiences.
- Support program processes and guideline updates to maintain CMS/HHS compliance, including contributing to Cigna IFP Coding Guideline revisions and policy decisions.
Benefits
- Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
- We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
